N-Acetylcysteine for Excoriation (Skin Picking) Disorder, Trichotillomania (Hair Pulling), and Obsessive Compulsive Disorder

Skin picking disorder is a disabling condition which consists of repeated picking of the skin leading to noticeable skin damage. It affects up to 5% of the population and no medication seems to be effective for the treatment of this disorder.

In a study published in the 3/23/2016 online issue of JAMA Psychiatry, Grant and colleagues report a decrease in skin-picking symptoms in a randomized double-blind 12-week study comparing 31 patients on placebo with 35 patients on N-acetylcysteine in a dosing range of 1200-3000 mg daily. N-acetylcysteine was well tolerated. Side effects were mild and included nausea (14% of participants]), dry mouth (3%), constipation (6%), and dizziness (3%). In a previous study, the same group found that N-acetylcysteine is also effective for the treatment of tricholamania, a condition characterized by a compulsive urge to pull out one’s hair resulting in hair loss, balding, and distress. Afshar and colleagues reported the effectiveness of N-acetylcysteine as an add-on treatment for refractory obsessive-compulsive disorder (OCD) treated with selective-serotonin-reuptake-inhibitor antidepressants.

N-acetylcysteine is an amino acid available without prescription. The authors hypothesize that N-acetylcysteine decreases compulsive behaviors by increasing extracellular levels of glutamate in the nucleus accumbens. Because skin-picking, trichotillomania, and OCD are chronic conditions, a treatment longer than 12 weeks may be necessary. Cognitive Behavioral Therapy (CBT) is also beneficial and should be combined with N-acetylcysteine.